Children and Adolescents with Multiple Health Conditions: How Research is Improving their Lives

Article by Jessica Zelman, Research Coordinator at McMaster University and the Offord Centre.

What did you worry about when you were a kid? Did you worry about whether it was safe for you to go to a baseball game, make a craft, or kiss someone for the first time? Kids with food allergies often worry about these common scenarios, along with many others, all the time. In fact, Kraft Peanut Butter has donated $100,000 to researchers at SickKids to find a cure for food allergies with the #InOnly10Years campaign, which aims to educate the public on food allergies by showing people how harmful it can be for young people to live with such constant fear and worry.

The role worry and anxiety plays in the lives of young people with food allergies cannot be underestimated. In fact, the link between physical and mental health is an important field of research that has been growing in recent years. And it’s not just food allergies that increase the chance that an individual will develop anxiety or other mental health problems – any physical health condition (asthma, diabetes, epilepsy) can put someone at risk.

It is this link between mental and physical health, known as multimorbidity, that Dr. Mark Ferro, psychiatric epidemiologist at the Offord Centre for Child Studies at McMaster University, is passionate about understanding – especially in children and adolescents. Dr. Ferro, director of the ARCH Lab (Advancing Research in Children’s Health), has studied children with different physical health conditions, in different settings. He has examined the perspectives of the children themselves, their parents, and their doctors. Over time, several questions have come up repeatedly about his program of research and what it means for the children who are living with multiple illnesses.

What is multimorbidity?

Multimorbidity is when an individual experiences two or more health conditions at the same time. In the case of our research, we are interested in how having a physical condition (e.g., food allergy, diabetes, epilepsy) and a mental health condition (e.g., depression, anxiety, ADHD) affects young people.

Why is this important to study in young people?

It is generally understood that individuals of any age with both a physical and mental health condition have decreased well-being and lower quality of life, their family experiences more stressors, and unsurprisingly, they tend to use more healthcare services.

Focusing our research on this developmental period is an effort to support young people with physical conditions to improve their life quality, decrease family stress, reduce mental health problems, and reduce healthcare use.

What is our approach to studying multimorbidity?

We tend to study multimorbidity in a “non-categorical” way. That is, grouping young people with any physical condition together, no matter what condition they might have. We do this because the effect of having a physical condition on mental health is about the same across different types of conditions. For example, in one of our studies we showed that young people with lung conditions were 44% more likely to have depression compared to healthy people. For young people with bone conditions it was 41% and for young people with conditions affecting their brain, it was 52%. We see similar patterns when we focus on one physical condition and different mental health problems. As the #InOnly10Years campaign emphasizes, we found that young people with food allergies were twice as likely to have depression and twice as likely to have anxiety compared to healthy young people.

Why is there a connection between mental and physical health conditions?

It makes sense that a young person who has a food allergy might feel more anxious than someone without food allergy, due to the extreme caution that is required to stay safe. But it might surprise you to know that the connection goes the other way too. People with mental health conditions are also at greater risk for developing physical health conditions, too.

There are a few ideas why. For example, having a physical condition could prevent young people from participating in activities with their friends which can lead to depression. Or, young people with mental health conditions may make unhealthy food choices leading to the development of diabetes.

Why do some people develop multimorbidity and others do not?

Not every young person with a physical health condition will be affected by multimorbidity. Each individual is unique and is born into a different set of circumstances. Each “circle” (shown in the diagram below) highlights a different layer of a person’s experience that can affect him/her in different ways.

Child/Individual Factors: severity of the illness, individual resilience and temperament, ability to use coping strategies – for example, young people who are able to “bounce back” when faced with adversity have better outcomes than those who aren’t as resilient

Family Factors: parenting style, overall family coping, presence of mental illness in parents – for example, a child with a physical condition is more affected by his/her mother’s depression than a healthy child

Environment: quality of support system, access to healthcare, relationships with peers – for example, children who have a chronic condition are more likely to be bullied than other children

What are some of the issues young people with multimorbidity and their families may experience in the healthcare system?

Young people and their families report difficulty and added stress when dealing with both mental and physical health conditions. They often describe frustration due to the lack of coordination of healthcare between the physical and mental aspects of their health. For example, a child with food allergy often has access to several immunology specialists within their circle of care: a pediatric allergist and nurse who would test for allergies using numerous tests at different time points, a dietician would help them learn which foods they should eat or stay away from, and a child life specialist would help them to understand the different procedures and tests they are undergoing. However, if this child was also experiencing mental health concerns, they would then require a referral to a mental health professional (often with very long wait times) who is outside of their circle of allergy care.

Another issue these families face is the transition from child to adult services. The problem stems from the fact that in the pediatric setting, children receive family-centred care. This means that the family factors discussed above are taken into account and families are informed and provide their opinion in the decision-making process. This is often not the case in the adult healthcare system. In addition to the change in the way services are delivered, parents also must transition giving up the responsibility of decision-making for their child. Often the transition is not managed well, and this can have negative effects on the health of young people. This problem is only worsened when the young person is experiencing more than one health condition.

Why is this research important?

Research on the health of young people with multimorbidity, or multiple health conditions,  is very important. At the individual level, better understanding of what these young people go through allows us to suggest improvements for service delivery, screening and treatment for at-risk children.

On a larger scale, this research aims to improve the coordination of care for all young people and reduces the healthcare costs associated with youth multimorbidity in Canada.

It is remarkable to see how far the field has come #InOnly10Years. What the next ten years will hold?